Increased Cardiovascular Disease Risk Factors Research Articles

A biobehavioral observational study to understand the multilevel determinants of cardiovascular health in Black women: the BLOOM Study protocol

BackgroundThe racial/ethnic and gender disparities in cardiovascular disease (CVD) morbidity and mortality in the United States are evident. Across nearly every metric, non-Hispanic Black women have poorer overall cardiovascular health. Emerging evidence shows a disproportionately high burden of increased CVD risk factors in Black women of childbearing age, which has a far-reaching impact on both maternal and child outcomes, resulting in premature onset of CVD and further widens the racial disparities in CVD. There is growing recognition that the fundamental driver of persistent racial/ethnic disparities in CVD, as well as disparities in behavioral risk factors such as physical activity and sleep, is structural racism. Further, the lived personal experience of racial discrimination not only has a negative impact on health behaviors, but also links to various physiological pathways to CVD risks, such as internalized stress resulting in a pro-inflammatory state. Limited research, however, has examined the interaction between daily experience and health behaviors, which are influenced by upstream social determinants of health, and the downstream effect on biological/physiological indicators of cardiovascular health in non-pregnant Black women of childbearing age.Methods/DesignThe BLOOM Study is an observational study that combines real-time ambulatory assessments over a 10-day monitoring period with in-depth cross-sectional lab-based physiological and biological assessments. We will use a wrist-worn actigraphy device to capture 24-h movement behaviors and electronic ecological momentary assessment to capture perceived discrimination, microaggression, and stress. Blood pressure will be captured continuously through a wristband. Saliva samples will be self-collected to assess cortisol level as a biomarker of psychological stress. Lab assessments include a fasting venous blood sample, and assessment of various indices of peripheral and cerebral vascular function/health. Participants’ address or primary residence will be used to obtain neighborhood-level built environmental and social environmental characteristics. We plan to enroll 80 healthy Black women who are between 18 and 49 years old for this study.DiscussionResults from this study will inform the development of multilevel (i.e., individual, interpersonal, and social-environmental levels) lifestyle interventions tailored to Black women based on their lived experiences with the goal of reducing CVD risk.ClinicalTrials.gov IdentifierNCT06150989.

Ab. No. 74 Women-Focused Cardiac Rehabilitation in India - An Urgent Need

Introduction: To review and highlight the current scenario of Cardiovascular disease (CVD) and Cardiac Rehabilitation (CR) offered to women in India and globally. CVD in women resulted in a 35% mortality rate among the total deaths worldwide in 2019. Women’s cardiovascular health needs additional attention because of increased CVD risk factors like diabetes, use of oral contraceptives, menopausal and postpartum issues, and low socioeconomic position. Globally, the rate of women screened, diagnosed, treated for CVD, and enrolled in rehabilitation is way more than in India. Method: Comprehensive literature search was done on search engines, PubMed and Google Scholar. Articles were selected based on the inclusion/exclusion criteria. 25 articles were screened and 16 were included and reviewed. A descriptive analysis was done. Result: The paper summarizes the increasing need and existing shortage of women-focused cardiac care in India. The male-female ratio of cardiac care utilization under Indian government policy was 70:30. Indian women’s low participation is due to financial dependency, lack of knowledge, and poor accessibility. There exists a lack of skilled professionals, dedicated CR centres pan India, and policies to advocate Women-focused CR (WFCR). Globally, 40.9% of countries have CR with 32.1% centres offering WFCR. These programs encompass community classes, home-based/online delivery models, women support groups, buddy programs, flexible scheduling, and comprehensive delivery of educational programs. Conclusion: The way forward for CR in India is to explore possibilities to reduce the barriers faced by women to avail of CR services. Policies need to be formulated to draw women’s attention to healthcare. Training programs should be introduced to upskill our nation’s young physiotherapy professionals. Implication: A bridge between CVD and CR must be formed and more women-centric CR programs should be designed for holistic cardiac health.

FRI411 Pharmacologically Induced Hypoestrogenism And Experimentally Induced Menopause-Pattern Sleep Fragmentation Independently Influence Circulating Lipids, Heart Rate, And Blood Pressure In Women

Abstract Disclosure: L.K. Grant: Grant Recipient; Self; Brigham and Women’s Hospital, Women’s Health Access Matters. A. Cohn: None. S. Crawford: None. J. Harder: Consulting Fee; Self; Altman Health, O’Rouke & Hawk, LLP. Grant Recipient; Self; Brigham and Women’s Hospital, President and Fellows of Harvard College. Owner/Co-Owner; Self; Jessica Harder, MD. Stock Owner; Self; Altman Health. Other; Self; Centerfield Media Holding Company. M.D. Nathan: None. I. Gonsalvez: None. T. Luo: None. E. Menezes: None. A. Roy: None. A. Wiley: None. F.A. Scheer: Consulting Fee; Self; University of Alabama. Other; Self; Board of Directors for the Sleep Research Society. E. Klerman: Consulting Fee; Self; American Academy of Sleep Medicine Foundation, Sleep Research Society Foundation, Circadian Therapeutics, National Sleep Foundation, Yale University Press. U.B. Kaiser: None. S. Mora: Consulting Fee; Self; Pfizer, Inc. J. Taylor: None. H. Joffe: Consulting Fee; Self; Bayer, Inc., Hello Therapeutics. Grant Recipient; Self; Merck, Pfizer, Inc., NIH. S.A. Rahman: Consulting Fee; Self; Sultan & Knight Limited, Bambu Vault LLC, Lucidity Lighting Inc. Grant Recipient; Self; Seoul Semiconductor Co. Ltd, Biological Innovation and Optimization Systems, LLC, Pfizer, Inc., Merck & Co., Lighting Science Group. Speaker; Self; Starry Skies Lake Superior, University of Minnesota Medical School, PennWell Corp, Seoul Semiconductor Co. Ltd. Stock Owner; Self; Melcort Inc. Introduction: The risk of cardiovascular disease (CVD) in women increases at menopause. Although declining levels of estradiol (E2) have been implicated in the increase in CVD risk for midlife women, it remains difficult to isolate these effects from the parallel changes in chronological age, and other potential contributing, mediating and modifying factors such as menopause-pattern sleep fragmentation (increased awakenings but no change in overall sleep duration). Here, we investigated whether hypo-estrogenism (hypo-E2) and sleep fragmentation increase CVD risk factors [lipids, blood pressure (BP)] in an experimental menopause model implemented in premenopausal women. Method: Two 5-night inpatient studies performed in the mid-to-late follicular phase (E2 = 48.7±29.5 pg/mL) and repeated following leuprolide-induced hypo-E2 (E2 = 7.5±5.9 pg/mL) were completed in 27 premenopausal women (mean age = 28.4±5.6 years). Each admission involved 2 nights of unfragmented sleep [8-h time-in-bed (TIB)] followed by 3 nights of sleep fragmentation, induced by auditory stimuli distributed across the night, producing 1-hr of cumulative wakefulness while enabling equal sleep opportunity (9-h TIB). BP and heart rate (HR) measurements were collected within 1 hour of wake in a semi-supine position each morning; fasting serum lipids were collected during unfragmented sleep and again after 3 nights of sleep fragmentation, during both inpatient stays. The effect of sleep fragmentation, E2 state and their interaction were assessed using generalized linear models to account for repeated measures. Results: Relative to the estrogenized state, the hypo-E2 state had a significant increase in total cholesterol (156±5 vs. 167±6 mg/dL, p<.001), triglycerides (72±5 vs 79±7 mg/dL, p<.001), HDL-C (58±3 vs. 62±3 mg/dL, p<.01), LDL-C (81±4 vs. 86±5 mg/dL, p<.05) and mean arterial pressure (MAP; 79±1 vs. 81±1 mmHg, p<.05) and a trend toward increased diastolic BP (63±1 vs. 65±1 mmHg, p=.07), with a significant compensatory decrease in HR (67±2 vs. 65±2 bpm, p<.001). Compared to the unfragmented sleep condition, sleep fragmentation resulted in a significant increase in HR (64±2 vs. 68±2 bpm, p<.001) and a trend toward increased systolic BP (109±1 vs. 110±1 mmHg, p=.08). There was no effect of sleep fragmentation on lipid levels, diastolic BP, or MAP, and no interaction between sleep fragmentation and E2 for any of the variables. Conclusion: These experimental findings show that pharmacologically induced hypo-E2, but not sleep fragmentation, increase circulating lipids levels in pre-menopausal women. Additionally, pharmacological E2-suppression increased BP and decreased HR, whereas sleep fragmentation increased both BP and HR. Together, these findings suggest that both E2 decline, and sleep fragmentation may uniquely contribute to the increase in CVD risk during the menopause transition. Presentation: Friday, June 16, 2023

Genetic Effect on Body Mass Index and Cardiovascular Disease Across Generations.

Whether genetics contribute to the rising prevalence of obesity or its cardiovascular consequences in today's obesogenic environment remains unclear. We sought to determine whether the effects of a higher aggregate genetic burden of obesity risk on body mass index (BMI) or cardiovascular disease (CVD) differed by birth year. We split the FHS (Framingham Heart Study) into 4 equally sized birth cohorts (birth year before 1932, 1932 to 1946, 1947 to 1959, and after 1960). We modeled a genetic predisposition to obesity using an additive genetic risk score (GRS) of 941 BMI-associated variants and tested for GRS-birth year interaction on log-BMI (outcome) when participants were around 50 years old (N=7693). We repeated the analysis using a GRS of 109 BMI-associated variants that increased CVD risk factors (type 2 diabetes, blood pressure, total cholesterol, and high-density lipoprotein) in addition to BMI. We then evaluated whether the effects of the BMI GRSs on CVD risk differed by birth cohort when participants were around 60 years old (N=5493). Compared with participants born before 1932 (mean age, 50.8 yrs [2.4]), those born after 1960 (mean age, 43.3 years [4.5]) had higher BMI (median, 25.4 [23.3-28.0] kg/m2 versus 26.9 [interquartile range, 23.7-30.6] kg/m2). The effect of the 941-variant BMI GRS on BMI and CVD risk was stronger in people who were born in later years (GRS-birth year interaction: P=0.0007 and P=0.04 respectively). The significant GRS-birth year interactions indicate that common genetic variants have larger effects on middle-age BMI and CVD risk in people born more recently. These findings suggest that the increasingly obesogenic environment may amplify the impact of genetics on the risk of obesity and possibly its cardiovascular consequences.

CARDIOMETABOLIC RISK IN INDIVIDUALS WITH BIPOLAR DISORDER AND THEIR OFFSPRING

Bipolar disorder (BD) is a highly heritable illness that is associated with increased risk of premature cardiovascular disease (CVD). Prior studies have observed increased CVD risk factors in unaffected adult relatives of adults with BD. Here we examined metabolic syndrome (MetS) and its components in a controlled study of adults with BD and their offspring.

Association of autoimmune blistering disease, and specifically, pemphigus vulgaris, with cardiovascular disease and its risk factors: a systematic review and meta-analysis.

Previous studies have found conflicting results about the association of autoimmune blistering disease (AIBD) with cardiovascular disease (CVD) risk. The objective of the study was to systematically review the relationship ofAIBD,includingpemphigus vulgaris (PV), and its treatment with CVD and CVD risk factors. MEDLINE, EMBASE, Cochrane, LILACS, SCOPUS, and Web of Science were searched. We included all studies of CVD and CVD risk factors in AIBD patients. Two reviewers performed title and/or abstract review and data extraction. Pooled random-effects meta-analysis was performed. Forty papers met inclusion criteria. AIBD was associated with higher odds of diabetes (DM) (odds ratio [95% confidence interval]: 1.809 [1.258-2.601]), hypertension (HTN) (1.393 [1.088-1.784]), dyslipidemia (2.177 [1.163-4.073]) and heart failure (1.919 [1.603-2.298]), but was not associated with obesity, stroke, angina, heart attack, or arrhythmia. The pooled random-effects prevalence for treatment-related adverse events (AEs) in AIBD was 13.7% for DM, 10.7% for HTN, and 17.1% for CVD. Sensitivity analysis of high-quality studies revealed similar results. AIBD patients have increased CVD risk factors and heart failure. Systemic corticosteroid treatment results in CVD-related AEs in AIBD. Increased CVD screening and prevention strategies are warranted in AIBD.

Obesity Pillars Roundtable: Obesity and South Asians

BackgroundCompared to other races/ethnicities, individuals from South Asia with obesity are strikingly susceptible to the presence of CVD risk factors and onset of CVD events – in part due to adiposopathic anatomic and metabolic responses to positive caloric balance. Pathogenic endocrine and immune effects of adipocyte hypertrophy and visceral fat accumulation both directly and indirectly promote among the most common metabolic diseases encountered in clinical practice – many being major cardiovascular disease (CVD) risk factors. This is especially applicable to those from South Asia – largely due to genetics, epigenetics, unhealthful nutrition, and physical inactivity. MethodsThis roundtable discussion included 4 obesity specialists engaged in the clinical management of obesity among patients of South Asian descent. ResultsPatients with obesity from South Asia have increased adipocyte size, fewer (functional) adipocytes, and increased visceral adiposity accompanied by functional endocrine and immune abnormalities. This helps explain the increased CVD risk factors and increased CVD risk among this unique population. These CVD risk factors include increased prevalence of metabolic syndrome (even at lower body mass index relative to other races), insulin resistance, type 2 diabetes mellitus, increased lipoprotein (a), and adiposopathic dyslipidemia [(i.e., elevated triglyceride levels, reduced high density lipoprotein cholesterol levels, increased low density lipoprotein (LDL) particle number, and increased prevalence of smaller and denser LDL particles]. ConclusionThe four panelists of this roundtable discussion describe their practical diagnostic processes and treatment plans for patients from South Asia, with an emphasis on a patient-centered approach to obesity in this unique population.

Abstract P400: The Association Between Cross-sex Hormone Therapy and Cardiovascular Disease Risk Factors Among Male-to-female Transgender Persons in Chiang Mai, Thailand

Background: Cross-sex hormone therapy (CSHT) is prescribed to transition secondary sexual characteristics among individuals undergoing male-to-female (MtF) transitions (age range 18-41, mean age=24). Limited data exist to inform the cardiovascular disease (CVD) risk factor profile associated with CSHT. We investigated the relationship between CSHT and cardiovascular risk factors in MtF transgender persons and hypothesize that CSHT will be associated with adverse CVD risk factor profiles. Methods: A cross-sectional study was conducted from October 1 st , 2018 to November 30 th , 2018 in 100 MtF transgender people not receiving CSHT vs. 100 receiving CSHT. CSHT use was defined by self-report use of up to 23 medications. Serum testosterone and 17-beta estradiol were assessed to validate CSHT use. Systolic and diastolic blood pressure was measured. Lipid profiles, fasting plasma glucose (FPG), C-reactive protein, cardiac troponin I and pro b-type natriuretic peptide (proBNP) were assessed from fasting blood. Non-invasive arterial examinations included: carotid intima-media thickness (CIMT), ankle-brachial index (ABI), cardio-ankle vascular index (CAVI), and pulse wave velocity (PWV). Multivariable linear regression models, regressed CVD risk factors on CSHT status. Among the subgroup of CSHT users, we assessed the relationship between duration of use and CVD risk factors. Multivariable models included age, gender, education, income, drinking, smoking, exercise, and BMI. Results: Participant mean age was 24±0.38 years and did not differ by CSHT use. Mean±SE values of testosterone were in the CSHT vs. control group were 4.8±0.3 vs. 5.8±0.3 ng/ml, p=0.06 and 17-beta estradiol levels were 45.6±14.9 vs. 34.7±14.8, p=0.7). CIMT was modestly lower among CSHT vs. controls (0.35±0.01 vs. 0.38±0.01, p=0.09). The average duration of CSHT use was 6.65±0.522 years. Among CSHT users, for every 1-year increase in duration of CSHT use total cholesterol decreased by -2.360 ± 1.096, p=0.0341 mg/dL, LDL-cholesterol decreased by -3.076 ± 1.182, p=0.0109 mg/dL, ABI decreased by -0.006 ± 0.002, p=0.0087 while FPG increased by 2.558 ± 0.899 mg/dL, p=0.0055. Conclusion: Among MtF transgender persons, using CSHT was not associated with increased CVD risk factors levels.

Cocoa Polyphenols: Evidence from Epidemiological Studies.

Accumulating evidence suggests potential preventive effects of chocolate/cocoa on the risk of cardio vascular disease (CVD). However, cocoa products also contain high levels of sugar and fat, which increase CVD risk factors. Even, the identity of the substance in chocolate/cocoa that has a favorable effect on CVD and CVD risk factors remains unclear, growing evidence from experimental studies suggests that cocoa polyphenols might be a major contributor to cardiovascular-protective effects. However, epidemiological studies, which are necessary to evaluate an association between the risk of CVD and cocoa polyphenol, remain sparse. We will discuss recent evidence regarding the association between cocoa polyphenol consumption and the risks of CVD and its risk factors by reviewing recent epidemiological studies. We shall also provide some guidance for patient counseling and will discuss the public health implications for recommending cocoa polyphenol consumption to prevent CVD. Epidemiological studies evaluating the association between cocoa polyphenol itself and the risk of CVD are sparse. However, evidence from limited epidemiological studies suggests that cocoa polyphenol consumption may lower the risk of CVD. Given the potential adverse effects of the consumption of cocoa products with high fat and sugar and the fact that the most appropriate dose of cocoa polyphenol for cardio-protective effects has not yet been established, health care providers should remain cautious about recommending cocoa/cocoa polyphenol consumption to their patients to reduce the risk of CVD, taking the characteristics of individual patients into careful consideration.

Barriers, facilitators, and effective interventions for lowering cardiovascular disease risk in people with severe mental illnesses: evidence from a systematic review and focus group study

BackgroundPeople with severe mental illnesses die early from cardiovascular disease (CVD). They have increased CVD risk factors, yet are less likely to receive appropriate treatments. Little is known about effective interventions to reduce CVD risk in severe mental illness. This study aimed to consolidate the best available evidence on lowering CVD risk in severe mental illness in primary care. Methods75 participants took part in 14 focus groups. Participants included people with severe mental illness, general practitioners, practice nurses, community mental health staff, and carers. Staff were asked to identify the training, resources, and systems required to lower CVD risk in severe mental illness, while access to services, motivation, and capability to lower CVD risk were explored with people with severe mental illness. Effective interventions were identified through a systematic review. We searched the Cochrane Library for systematic reviews of randomised controlled trials (RCTs) and the Cochrane Schizophrenia and Cochrane Depression, Anxiety and Neurosis Group Trial Registers between 1966 and 2014 for additional RCTs. Search terms were (schizophrenia, severe mental illness, bipolar, mania, manic, hypomani*, psychos*, psychotic, rapid cycling, schizoaffective) AND (physical, cardio*, metabolic, weight, tobacco, smok, medical, alcohol, nutrition, diet, health, diabet*, blood pressure, hypertension, cholesterol, statin). Non-English language papers were excluded. Data from included studies were extracted with a template to record methodological and substantive characteristics. FindingsFocus groups identified five barriers: negative perceptions of severe mental illnesses, difficulties accessing services, difficulties managing a healthy lifestyle, not attending appointments, and lack of awareness of CVD risk. Five facilitators included social support, improving patient engagement, continuity of care, positive feedback, and goal setting. 15 systematic reviews and 28 additional RCTs were included. Effective pharmacological and behavioural interventions to manage weight and promote smoking cessation or reduction were identified. There was minimal evidence of effective interventions to reduce alcohol use and blood glucose and no evidence for interventions targeting cholesterol, hypertension, or diabetes. InterpretationCVD risk attributable to weight and smoking can be reduced in severe mental illness; other risk factors must currently be managed as for other populations. However we identified factors that can be incorporated in the design, delivery, and evaluation of services to reduce CVD risk for people with severe mental illness in primary care. New interventions should address these barriers and harness facilitating factors to reduce CVD risk in this population. FundingThis work was funded as part of a National Institute for Health Research Programme grant for applied research (ref RP-PG-0609-10156).

Influences of gender on cardiovascular disease risk factors in adolescents with and without type 1 diabetes.

BackgroundWomen with type 1 diabetes (T1D) have a four-fold increased risk for cardiovascular disease (CVD) compared to non-diabetic (non-DM) women, as opposed to double the risk in T1D men compared to non-DM men. It is unclear how early in life CVD risk differences begin in T1D females. Therefore, our objective was to compare CVD risk factors in adolescents with and without T1D to determine the effects of gender on CVD risk factors.MethodsThe study included 300 subjects with T1D (age 15.4±2.1 years, 50 % male, 80 % non-Hispanic White (NHW), glycated hemoglobin (A1c) 8.9±1.6 %, diabetes duration 8.8±3.0 years, BMI Z-score 0.62±0.77) and 100non-DM controls (age 15.4±2.1 years, 47 % male, 69 % NHW, BMI Z-score 0.29±1.04). CVD risk factors were compared by diabetes status and gender. Multivariate linear regression analyses were used to determine if relationships between diabetes status and CVD risk factors differed by gender independent of differences in A1c and BMI.ResultsDifferences in CVD risk factors between T1D subjects and non-DM controls were more pronounced in girls. Compared to boys with T1D and non-DM girls, T1D girls had higher A1c (9.0 % vs. 8.6 % and 5.1 %, respectively), BMI Z-score (0.70 vs. 0.47 and 0.27), LDL-c (95 vs. 82 and 81 mg/dL), total cholesterol (171 vs. 153 and 150 mg/dL), DBP (68 vs. 67 and 63 mmHg), and hs-CRP (1.15 vs. 0.57 and 0.54 mg/dL) after adjusting for Tanner stage, smoking status, and race/ethnicity (p <0.05 for all). In T1D girls, differences in lipids, DBP, and hs-CRP persisted even after adjusting for centered A1c and BMI Z-score.Testing interactions between gender and T1D with CVD risk factors indicated that differences were greater between girls with T1D and non-DM compared to differences between boys with T1D and non-DM. Overall, observed increases in CVD risk factors in T1D girls remained after further adjustment for centered A1c or BMI Z-score.ConclusionsInterventions targeting CVD risk factors in addition to lowering HbA1c and maintaining healthy BMI are needed for youth with T1D. The increased CVD risk factors seen in adolescent girls with T1D in particular argues for earlier intervention to prevent later increased risk of CVD in women with T1D.

Modulating the Gut Microbiota Improves Glucose Tolerance, Lipoprotein Profile and Atherosclerotic Plaque Development in ApoE-Deficient Mice.

The importance of the gut microbiota (GM) in disease development has recently received increased attention, and numerous approaches have been made to better understand this important interplay. For example, metabolites derived from the GM have been shown to promote atherosclerosis, the underlying cause of cardiovascular disease (CVD), and to increase CVD risk factors. Popular interest in the role of the intestine in a variety of disease states has now resulted in a significant proportion of individuals without coeliac disease switching to gluten-free diets. The effect of gluten-free diets on atherosclerosis and cardiovascular risk factors is largely unknown. We therefore investigated the effect of a gluten-free high-fat cholesterol-rich diet, as compared to the same diet in which the gluten peptide gliadin had been added back, on atherosclerosis and several cardiovascular risk factors in apolipoprotein E-deficient (Apoe-/-) mice. The gluten-free diet transiently altered GM composition in these mice, as compared to the gliadin-supplemented diet, but did not alter body weights, glucose tolerance, insulin levels, plasma lipids, or atherosclerosis. In parallel, other Apoe-/- mice fed the same diets were treated with ampicillin, a broad-spectrum antibiotic known to affect GM composition. Ampicillin-treatment had a marked and sustained effect on GM composition, as expected. Furthermore, although ampicillin-treated mice were slightly heavier than controls, ampicillin-treatment transiently improved glucose tolerance both in the absence or presence of gliadin, reduced plasma LDL and VLDL cholesterol levels, and reduced aortic atherosclerotic lesion area. These results demonstrate that a gluten-free diet does not seem to have beneficial effects on atherosclerosis or several CVD risk factors in this mouse model, but that sustained alteration of GM composition with a broad-spectrum antibiotic has beneficial effects on CVD risk factors and atherosclerosis. These findings support the concept that altering the microbiota might provide novel treatment strategies for CVD.

Childhood cardiovascular risk factors, a predictor of late adolescent overweight.

Background:We conducted a prospective study to elucidate the effects of increased cardiovascular risk factors on future weight gain and also the relation between body mass index (BMI) and other cardiovascular risk factors in children and adolescents.Materials and Methods:This study was conducted on 1525 nonobese children and adolescents with an age range of 3-16 years old, participating in the 1st phase and follow-up phases of Tehran Lipid and Glucose Study. The subjects were evaluated 4 times with a 3-year time interval regarding lipid profile status and BMI, and other cardiovascular disease (CVD) risk factors. All the cases had a BMI <85% and had been appraised in at least two evaluation points.Results:Cardiovascular risk factors, high-density lipoprotein (HDL) (P = 0.019), low-density lipoprotein (P = 0.016), triglyceride (TG) (P < 0.001), and blood pressure (BP) (P = 0.001); had significant effects on weight gain. There was also no difference between boys and girls and no age trend for increasing weight in both groups. The associations between BMI with cardiovascular risk factors were assessed cross-sectionally. For both sexes, BMI was significantly correlated to systolic and diastolic BP and TG (P = 0.05). For girls, BMI was significantly related to HDL (P = 0.05) regardless to age, but in boys, the relation of BMI with HDL only increased with age (P = 0.05).Conclusion:Increased CVD risk factors are predictors of future overweight in childhood and adolescent and increased weight is linked significantly with dyslipidemia and hypertension in this age group.

ADVERSE CHILDHOOD EVENTS INCREASE THE RISK OF BEHAVIOURAL AND CLINICAL CARDIOVASCULAR RISK FACTORS

While cardiovascular disease (CVD) is the leading cause of mortality, the “actual” leading causes of death include behaviours such as smoking, poor diet and physical inactivity. Prevention focuses on the modification of these adult risk factors, however many of these processes have their origins in childhood and adolescence. It is postulated that adverse childhood experiences (ACE), which includes a negative home environment, physical, emotional and sexual abuse, can lead to stress-response changes that negatively impact behaviours throughout life. Objectives: To determine: 1) the prevalence and socio-demographic characteristics of ACE among a nationally represented population and 2) the association of ACE categories with behavioural and clinical risk factors. We used the 2009 and 2011 Behavioural Risk Factor Surveillance System, a nationally representative survey of participants ages 18-99 years. Data included individuals that provided information on ACE, health behaviours and CVD risk factors. We captured distributions via frequency and percentage counts and ACE categories as an ordinal variable of cumulative burden. Multivariable logistic regression models tested the association of the burden of ACE categories with outcome variables of behavioural and clinical risk factors. Amongst 45,644 study participants, 52% reported at least one ACE, 25% reported at least two ACE categories. Among the ACE, 37% reported a Bad home, 34% reported Direct abuse and 12% reported Sexual abuse. A strong association exists between even one ACE and the behavioural and clinical risk factors including obesity (OR=1.3 95%CI 1.2-1.4), physical inactivity (OR=1.1, 95%CI 1.0-1.1), heavy drinking (OR=1.3, 95%CI 1.2-1.5), current smoking (OR=1.7, 95%CI 1.6-1.8), hypertension (OR=1.1, 95%CI 1.1-1.2), dyslipidemia (OR=1.3, 95%CI 1.3-1.4) and diabetes (OR=1.2, 95%CI 1.1-1.3). Further, the number of ACE categories was strongly associated with each risk factor in a dose-response relationship (p for trend, all p<0.001). More than half of this nationally represented population experienced an adverse childhood event and we found that the presence of even one ACE is strongly associated with behavioural and clinical CVD risk factors, identifying key childhood risk factors that increase CVD risk factors. While ACE in itself may be non-modifiable, future studies need to determine how to effectively implement prevention strategies among this high-risk group.

Does sufficient evidence exist to support a causal association between vitamin D status and cardiovascular disease risk? An assessment using Hill's criteria for causality.

Serum 25-hydroxyvitamin D (25(OH)D) levels have been found to be inversely associated with both prevalent and incident cardiovascular disease (CVD) risk factors; dyslipidemia, hypertension and diabetes mellitus. This review looks for evidence of a causal association between low 25(OH)D levels and increased CVD risk. We evaluated journal articles in light of Hill’s criteria for causality in a biological system. The results of our assessment are as follows. Strength of association: many randomized controlled trials (RCTs), prospective and cross-sectional studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Consistency of observed association: most studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors in various populations, locations and circumstances. Temporality of association: many RCTs and prospective studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Biological gradient (dose-response curve): most studies assessing 25(OH)D levels and CVD risk found an inverse association exhibiting a linear biological gradient. Plausibility of biology: several plausible cellular-level causative mechanisms and biological pathways may lead from a low 25(OH)D level to increased risk for CVD with mediators, such as dyslipidemia, hypertension and diabetes mellitus. Experimental evidence: some well-designed RCTs found increased CVD risk factors with decreasing 25(OH)D levels. Analogy: the association between serum 25(OH)D levels and CVD risk is analogous to that between 25(OH)D levels and the risk of overall cancer, periodontal disease, multiple sclerosis and breast cancer. Conclusion: all relevant Hill criteria for a causal association in a biological system are satisfied to indicate a low 25(OH)D level as a CVD risk factor.

Abstract P174: Increased Cardiovascular Disease Risk Factors in Young Hispanic Women at the High-end of Normal-weight Body Mass Index

BMI is often used to assess risk of cardiovascular disease (CVD); however, current BMI cutpoints may not be accurate for all ethnicities. Given the high prevalence of obesity and type 2 diabetes in Hispanics, it is important to examine whether current BMI cutpoints accurately identify those at healthy weight and those at risk. We examined whether there was a difference in CVD risk factors within the normal-weight BMI category in young, Hispanic women. We hypothesized that women in the highest tertile of normal-weight would have significantly more CVD risk factors than those in the lowest tertile of normal-weight. Sixty nine normal-weight Hispanic women (20-39 y) were divided into tertiles of normal-weight BMI: 18.5-20.9 kg/m2 (NW low, n=17), 21.0-22.9 kg/m2 (NW mid, n=31) and 23.0-24.9 kg/m2 (NW high, n=21). CVD risk factors measured included waist circumference, blood pressure and fasting glucose, triglycerides and high-density and low-density lipoprotein. Glucose tolerance was measured by a 2h oral glucose tolerance test. Body composition was measured by dual-energy x-ray absorptiometry. Intra-abdominal adipose tissue, an estimate of visceral adiposity, was calculated. Data were analyzed using multivariate ANOVA, with Levine’s test indicating homogeneity of variances among groups, and Kruskal-Wallace test. Post hoc tests included Bonferroni and Mann Whitney. Results indicated the prevalence of women who were risk factor free was 65%, 39% and 24% for NW low, mid and high, respectively. The prevalence of women with one or more CVD risk factors was 35%, 61%, and 76% for NW low, mid and high, respectively. The prevalence of women with two or more CVD risk factors was 0%, 3%, and 29% for NW low, mid and high, respectively. The prevalence of women with three or more CVD risk factors was 0%, 0% and 10% for NW low, mid and high, respectively. Overall the prevalence of CVD risk factors was significantly higher in NW high than NW low (p=0.006) and NW mod (p=0.04) and approached significance between NW mid and NW low (p=0.08). There was a significant increase in percentage body fat (27.6±5.1%, 30.7±4.6%, 36.9±4.6%, respectively), intra-abdominal adipose tissue (24.2±7.9 cm2, 45.6±12.2 cm2, 66.5±19.7 cm2, respectively), and waist circumference (71.2±3.1 cm, 76.6±4.8 cm, 81.0±5.8 cm, respectively) from NW low to NW high (p&lt;0,001). NW high had significantly higher triglyceride levels than NW low (86.4±40.0 mg/dL vs. 58.9±20.6 mg/dL, p=0.04) and significantly higher 2h glucose levels than NW mid (120.0±27.9 mg/dL vs. 99.1±17.3 mg/dL, p=0.003). In conclusion, young, Hispanic women at the upper-end of the normal-weight BMI range had a significantly higher prevalence of CVD risk factors, body fat and central obesity than women in the mid and lower end of normal-weight BMI range. These findings suggest that the normal-weight BMI cutpoint may need to be adjusted for Hispanic women.

Complete Blood Cell Count Biomarkers Provide No Additional Benefit Over Traditional Lipid Biomarkers for Assessing Cardiovascular Disease Risk in Non-alcoholic Steatohepatitis

Purpose: Non-alcoholic steatohepatitis (NASH) has been associated with increased cardiovascular disease (CVD) risk compared with individuals without NASH. Recently, the neutrophil/lymphocyte (N/L) ratio and the mean platelet volume (MPV) have been proposed as independent predictors and risk factors of CVD. In this study, we evaluated whether the N/L ratio and MPV provided any additional benefit to the more traditional lipid biomarkers of CVD in a well characterized cohort of NASH patients. Methods: We compared biopsy proven NASH patients with a control group of subjects with no evidence of fatty liver on imaging or who had a normal liver biopsy. Subjects with gastric bypass surgery were excluded. The groups were matched 1:1 based on age, body mass index, gender, diabetes and hypertension. The groups were compared on different indirect markers of cardiovascular risk. Results: There were 93 subjects in each group. Both groups had 50 (53.8%) females. The mean age was 50.4 (+10.5) years in the control group and 50 (+10.9) years in the NASH group. The mean body mass index was 33 for both groups with 73 obese subjects in the control group and 72 in the NASH group. The groups had diabetes present in 32% and hypertension in 48%. The NASH group had significantly lower high density lipoprotein (HDL) levels (45+12.6 mg/dL vs. 52.6+12.9 mg/dL; p <0.002) and higher triglyceride (TG) levels (152 [108, 195] mg/dL vs. 109 [68, 177] mg/dL; p=0.015). The NASH group had a lower N/L ratio (NASH 2.2+1.3 vs. controls 2.8+1.8; p=0.021). There was no significant difference in MPV between the two groups (NASH 10.8+0.92 vs. controls 10.5+0.91; p=0.097). SH patients have increased CVD risk factors but the newly proposed complete blood cell count biomarkers of CVD, N/L ratio and MPV, provide no additional benefit over the more traditional lipid biomarkers.Table: Cardiovascular risk measures

Cognitive impairment in persons with rheumatoid arthritis

To explore the prevalence and possible predictors of cognitive impairment in persons with rheumatoid arthritis (RA). Individuals from a longitudinal cohort study of RA participated in a study visit that included a range of physical, psychosocial, and biologic metrics. Cognitive function was assessed using a battery of 12 standardized neuropsychological measures yielding 16 indices. Subjects were classified as "impaired" if they performed 1 SD below age-based population norms on at least 4 of 16 indices. Logistic regression analyses were conducted to identify which of the following were significant predictors of cognitive impairment: sex, race, income, education, depression, disease duration, disease severity, C-reactive protein (CRP) level, glucocorticoid use, and cardiovascular disease (CVD) risk factors. A total of 115 subjects with a mean ± SD age of 58.6 ± 10.8 years were included; 64% were women and 81% were white. The proportion of persons who were classified as cognitively impaired was 31%. Education, income, glucocorticoid use, and CVD risk factors independently predicted cognitive impairment, controlling for sex, race, disease duration, disease severity, CRP level, and depression. Individuals with cognitive impairment were more likely to have low education (odds ratio [OR] 6.18, 95% confidence interval [95% CI] 1.6-23.87), have low income (OR 7.12, 95% CI 1.35-37.51), use oral glucocorticoids (OR 2.92, 95% CI 1.05-8.12), and have increased CVD risk factors (OR 1.61, 95% CI 1.19-2.17 per risk factor). The findings of this study suggest that the burden of cognitive impairment in RA is significant, and future studies identifying specific etiologic contributors to cognitive impairment are warranted.

Distribution of 10-Year and Lifetime Predicted Risk for Cardiovascular Disease Prior to Surgery in the Longitudinal Assessment of Bariatric Surgery-2 Study

Primary prevention guidelines recommend calculation of lifetime cardiovascular disease (CVD) predicted risk in patients who may not meet criteria for high short-term (10-year) Adult Treatment Panel III risk for coronary heart disease (CHD). Extreme obesity and bariatric surgery are more common in women who often have low short-term predicted CHD risk. The distribution and correlates of lifetime CVD predicted risk, however, have not yet been evaluated in bariatric surgical candidates. Using established 10-year (Adult Treatment Panel III) CHD and lifetime CVD risk prediction algorithms and presurgery risk factors, participants from the Longitudinal Assessment of Bariatric Surgery-2 study without prevalent CVD (n = 2,070) were stratified into 3 groups: low 10-year (<10%)/low lifetime (<39%) predicted risk, low 10-year (<10%)/high lifetime (≥39%) predicted risk, and high 10-year (≥10%) predicted risk or diagnosed diabetes. Participants were predominantly white (86%) and women (80%) with a median age of 45 years and median body mass index of 45.6 kg/m(2). High 10-year CHD predicted risk was common (36.5%) and associated with diabetes, male gender, and older age, but not with higher body mass index or high-sensitivity C-reactive protein. Most participants (76%) with low 10-year predicted risk had high lifetime CVD predicted risk, which was associated with dyslipidemia and hypertension but not with body mass index, waist circumference, high-density lipoprotein cholesterol, or high-sensitivity C-reactive protein. In conclusion, bariatric surgical candidates without diabetes or existing CVD are likely to have low short-term, but high lifetime CVD predicted risk. Current data support the need for long-term monitoring and treatment of increased CVD risk factors in bariatric surgical patients to maximize lifetime CVD risk decrease (clinical trial registration, Long-term Effects of Bariatric Surgery, indentifier NCT00465829, available at: http://www.clinicaltrials.gov/ct2/results?term=NCT00465829).

Dietary behaviors associated with cardiovascular disease risk factors in Mexican‐American adults

To identify dietary behaviors associated with cardiovascular disease (CVD) risk among Mexican Americans, data on frequency of eating out, consumption of traditional Mexican foods, food group intake, and CVD risk factors were collected in 65 Mexican‐American adults (21 male, 44 female; age=37±10 y; BMI=28.6±5.6 kg/m2; total‐cholesterol [C]=184±40 mg/dL; LDLC= 115±33 mg/dL; HDL‐C=45±11 mg/dL; triglycerides [TG]=129±146 mg/dL). Restaurant dining frequency (11±10 times/month) was positively correlated with total‐C (r=0.250, p&lt;0.05) and LDL‐C (r=0.270, p&lt;0.05). Individuals eating out more frequently (&gt;8.75 times/month) had 26% greater total‐C (205±40 mg/dL vs. 163±29 mg/dL; p&lt;0.0001) and 31% greater LDL‐C (130±33 vs. 99±25; p&lt;0.0001) than those with fewer restaurant visits. Frequency of traditional Mexican food intake (4±2 times/week) was correlated positively with TG (r=0.251, p&lt;0.05) and negatively with HDL‐C (r=−0.252, p&lt;0.05). Eating out and consuming traditional Mexican foods were inversely correlated with fruit intake (r=−0.249 and r=−0.254, respectively; p&lt;0.05). Data suggest that choosing restaurant and/or traditional Mexican foods more frequently may increase CVD risk factors in Mexican Americans. This relationship and how Mexican Americans define ‘traditional Mexican food’ merit further investigation. Funded by Arizona State University.